Abstract
Background: Laparoscopic cholecystectomy is widely used for cholelithiasis. Abdominal ultrasonography often precedes this operation and can prove diagnosis, as well as helps in showing possible complications during the perioperative period. Aim: Evaluate the description of variables of gallbladder and bile ducts present in reports of preoperative abdominal ultrasonography in cholelithiasis comparing with surgical findings. Methods: Were studied 91 patients who underwent elective laparoscopic cholecystectomy with previous abdominal ultrasonography. Variables such as identification and amount of gallstones involved were evaluated, both in preoperative ultrasonography and during surgery to evaluate sensitivity, specificity, concordance and positive and negative predictive values. Results: The reports did not mention diameter of vesicular light (98.9%), organ distension (62.6%), gallstone sizes (58.2%), wall thickness (41.8%) and evaluation of the common bile duct (39.6%). Ultrasound had high values for sensitivity, consistency and positive predictive value for identifying the presence/absence of gallstones: 98.8%, 96.7% and 97.8% respectively. As for the amount of stones, ultrasonography showed agreement in 82.7%, negative predictive value in 89.1% and specificity in 87.7%, with lower values for sensitivity (68.2%) and positive predictive value (65.2%). Conclusions: The ultrasound reports were flawed in standardization. Significant percentage of them did not have variables that could predict perioperative complications and surgical conversion.
Highlights
Cholelithiasis has worldwide scope, with estimated incidence of 1.39/100 person/year, varying little between populations
In the US, the third evaluation of the National Health and Nutrition Examination Survey estimated that 6.3 million men and 14.2 million women aged 20-74 years have cholelithiasis, of which 1-3% become symptomatic[9]
Acute cholecystitis is suspected in patients with pain in the right upper quadrant or epigastrium, fever and leukocytosis; clear Murphy signal sustains the diagnosis[28]
Summary
Cholelithiasis has worldwide scope, with estimated incidence of 1.39/100 person/year, varying little between populations. Laparoscopic cholecystectomy is the treatment of choice, with mortality and morbidity of approximately 0.5% and 10%, respectively[13]. This procedure has advantages when compared to laparotomy, such as reducing the length of hospital stay, incidence and intensity of pain in the postoperative period, better aesthetic effects and minor surgical trauma[14]. To confirm the preoperative diagnosis, abdominal ultrasonography (USG) is the most frequently used exam, being diagnostic method with relative low cost, free of ionizing radiation, non-invasive and practical realization.
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